Primary Hepatic Pregnancy Research Articles

Liver resection for primary ectopic hepatic pregnancy

Liver resection for primary ectopic hepatic pregnancy

Primary hepatic pregnancy

Introduction. Hepatic pregnancy is an extremely rare form of ectopic pregnancy, and represents a difficult challenge for both diagnostics and treatment. Case outline. A 40-year-old gravida 0 para 0 patient in 6 + 0 gestational weeks was admitted to the hospital with lower abdominal pain, positive bHCG values, and presence of free intra-abdominal fluid. She had a history of infertility, and also a previous surgery due to pelvic endometriosis. Urgent open surgery was performed due to signs of hypovolemic shock. We discovered a rupture of the left ovarian corpus luteum cyst. Bleeding management was achieved with preservation of ovarian tissue. Patient recovered, bHCG levels continued to rise, and five days after surgery free intra-abdominal fluid reappeared with upper abdominal pain and tenderness. After transferring patient to abdominal surgery clinic, second surgery was performed, where we confirmed the presence of hepatic pregnancy. After this procedure, patient fully recovered. Conclusion. The method of choice for an ectopic pregnancy treatment is laparoscopic surgery, but when laparoscopy is not possible, the site of ectopic pregnancy could be difficult to diagnose. Prolonged time for making accurate diagnosis increases the risk of ectopic pregnancy complications.

Primary Hepatic Pregnancy.

Primary Hepatic Pregnancy.

Primary hepatic pregnancy: report of a case treated with laparoscopic approach and review of the literature

To report a case of primary hepatic pregnancy complicated by acute hemoperitoneum that was treated with a laparoscopic approach. Case report and review of the literature. Obstetrics and gynecology unit of a university hospital. A 37-year-old pregnant woman who presented with vaginal bleeding. Diagnosis by abdominal ultrasound and computed tomography. Patient recovery after minimally invasive laparoscopic surgery and monitoring. A hepatic ectopic pregnancy complicated by hemoperitoneum was diagnosed. The hepatic pregnancy was surgically removed via laparoscopy through a retroperitoneal approach, and the patient's human chorionic gonadotropin level was subsequently monitored. The patient's postoperative course was uneventful, and the serum human chorionic gonadotropin level dropped to zero. Only 39 cases of hepatic pregnancy have been reported in the literature, making it an exceptional category among abdominal pregnancies. Hepatic localization should be ruled out in cases of unknown pregnancy location. Abdominal ultrasound has a key role detecting hepatic localization and excluding other abdominal implantation sites. Laparoscopic surgery represents a feasible approach for the treatment of first trimester hepatic pregnancies.

Gestational progression and blood supply assessment of a six-week primary hepatic pregnancy

Background: Primary hepatic pregnancy is a rare, but potentially fatal extra-uterine (ectopic) pregnancy. Most cases are missed in early pregnancy and frequently result in acute abdomen and hemorrhage during the first trimester. Only two cases reported were diagnosed prior to ten weeks of pregnancy. Case Report: The authors report one case of six-week primary hepatic pregnancy with timely diagnosis and subsequent evaluation by abdominal ultrasonography and describe the blood supply increasing of early hepatic pregnancy in 72 hours by color Doppler imaging. Discussion: Hepatic pregnancy progresses rapidly and the rupture risk increases day by day due to the rapid vessel-growth. When pelvic US fails to identify ectopic pregnancy, the present authors recommend a thorough abdominal US scan to expedite location of the gestational sac (GS) as early as possible. This is the mainstay of management to avoid serious potential complications. Lack of awareness about this condition may lead to missing or delaying diagnosis. Conclusion: It is very important that the clinician be aware of this condition with a high level of suspicion when pelvic US fails to locate the ectopic pregnancy.

Diagnosis and management of primary hepatic pregnancy: literature review of 31 cases

To summarize the appropriate diagnostic methods and therapeutic options for primary hepatic pregnancy (PHP). Literature searches were performed in Pubmed, Web of Science, Cochrane Library and Embase databases (1956-2017), using the following search terms: primary hepatic pregnancy, hepatic pregnancy, liver pregnancy, hepatic ectopic pregnancy and intrahepatic pregnancy. Further literature was confirmed through cross-referencing. Thirty-one cases were reviewed and collected. The site mostly described in literatures is the right lobe of liver (93.5%). Main symptoms of PHP included abdominal pain (77.4%), amenorrhea (45.2%), acuteperitonism (32.3%), shock (25.8%) and vomit (16.1%). Majority of patients (83.9%) were treated by laparotomy. Less-invasive approaches (16.1%) such as laparoscopy or combination of postoperative injection of methotrexate were used less frequently. The outcome was acceptable at the end of the follow-up period in ten cases (1-72months) and the recovery rate was 96.7%. One patient died and other complications were noted in three patients during the postoperative period. The clinical diagnosis of PHP can be settled up by comprehensive analysis of serum HCG levels, ultrasound and imaging. The analysis should be assessed carefully before therapeutic procedure. Invasive methods should be preferential. Less-invasive approaches can be selected when the patients have stable hemodynamics and non-acute abdomen.

Primary hepatic pregnancy

Primary hepatic pregnancy

The imaging of primary hepatic pregnancy:a case report

The imaging of primary hepatic pregnancy:a case report

Contrast-enhanced multiphasic CT and MRI of primary hepatic pregnancy: a case report and literature review

Primary hepatic pregnancy is extremely rare and difficult to diagnose radiologically. We present a 32-year-old woman with primary hepatic pregnancy diagnosed by using multi-modality imaging techniques, including ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI), which highlights diagnostic challenges. These techniques can define tissue planes in detail and identify embryo implantation into the hepatic parenchyma, thereby allowing accurate preoperative diagnosis and preoperative planning by the surgical team. To the best of our knowledge, this study is the first in the English literature to report a case of primary hepatic pregnancy, in which diffusion-weighted and contrast-enhanced multiphasic MRI were utilized for diagnosis and evaluation.

Successful management of primary hepatic pregnancy with selective hepatic artery embolization and intra-arterial methotrexate infusion

Primary hepatic pregnancy is an extremely rare and lifethreatening condition. Fatal hemorrhage after rupture of an ectopic pregnancy is the most feared complication, and any rupture must be managed with emergency surgery. A 31-year-old patient (G6, P2) presented with amenorrhea of 8 weeks’ duration and acute onset of right upper abdominal pain. The patient was hemodynamically unstable and had diffused abdominal tenderness. Hemoglobin concentration was 6.8 g/dL. Coagulation function was normal. Serum hCG level was 23 824 mIU/mL. Pelvic ultrasonography revealed marked echogenic fluid in the pouch of Douglas, but no gestational sac was identified. The patient underwent emergency exploratory laparotomy through a lower abdominal midline incision. The abdominal cavity contained approximately 1000 mL of blood. The uterus, ovaries, and fallopian tubes were normal. Further exploration of the abdomen revealed that the hemorrhage arose from the hepatic area, and the incision was extended vertically to the upper abdomen with the assistance of a general surgeon. The active bleeding continued from a rupture in a 3.0 x 4.0-cm whitish, villiform nodule on the inferior surface of the liver. The nodule could not be removed completely because of deep implantation into the hepatic parenchyma and hilum. Hemostasis was obtained by plication of the bleeding site using absorbable sutures. Histopathologic examination of the liver nodule revealed normal chorionic villi, consistent with the diagnosis of primary hepatic pregnancy. The patient’s hCG level dropped to 10 355 mIU/mL on postoperative day 1, but rose to 11 230 mIU/mL 2 days later. Given the residual elevated hCG level and associated risk of secondary hemorrhage, transcatheter arterial chemoembolization (TACE) with intra-arterial methotrexate infusion was performed to diminish the local blood supply to the lesion and degenerate residual trophoblasts using methotrexate at the same time. The patient’s liver and renal functions were normal before TACE. A common femoral artery approach was used, and hepatic angiography showed a 2.5 x 3.0-cm mass supplied by the right hepatic artery (Fig. 1A). A mixture of 6 mL of Lipiodol (iodized oil; Guerbet, Roissy, France) and 50 mg (1 mg/kg) of methotrexate was infused via the microcatheter as close as possible to the feeding branch, followed by embolization of the feeding artery with gelatin sponge particles (0.5–1.0 mm).A methotrexate–Lipiodol emulsion was used to localize the methotrexate inside the hepatic lesion and release it slowly [1]. After embolization, X-ray examination was performed to confirm the deposition of Lipiodol inside the lesion (Fig. 1B). The patient’s recovery was uneventful. Serum hCG level decreased steadily and was undetectable 12 days after TACE. Liver and renal function tests were performed every 3 days until the patient’s hCG level normalized and remained within limits. One month later, ultrasound examination of the patient’s liver revealed no trace of the ectopic pregnancy. A previous report described slow hemorrhage from hepatic pregnancy managed by laparoscopy and postoperative administration of methotrexate [2]. In two unruptured cases, local methotrexate injection into the hepatic gestational sac was performed under direct [3] or ultrasound guidance [4]. However, additional methotrexate administration was often required for persistently elevated hCG level after surgery and caused prolonged recovery time. TACE induces an acute ischemic degeneration of trophoblasts and avoids secondary hemorrhage. Moreover, the block of blood flow to the lesion exposes the local trophoblastic mass to a higher concentration of methotrexate than intramuscular administration and prevents severe adverse effects. The combination of these two mechanisms may help accelerate the decrease in serum hCG level and shorten the time to resolution of the trophoblastic mass. TACE with intraInternational Journal of Gynecology and Obstetrics 122 (2013) 78–86

Laparoscopic management of primary hepatic pregnancy

A 30-year-old woman presented with epigastric pain with elevated serum human chorionic gonadotropin level (hCG), absence of intrauterine gestational sac and absence of an abnormal adnexal mass on pelvic ultrasonography. Laparoscopy revealed a ruptured hepatic ectopic pregnancy. This was removed by laparoscopic suctioning and haemostasis secured with Surgicel((R)) Fribrilla Absorbable Hemostat. Intramuscular methotrexate was administered post-operatively. Patient recovered uneventfully and serum hCG returned to normal.

Primary hepatic pregnancy

Abdominal pregnancies are a small fraction of ectopic pregnancies. They usually implant on the peritoneal surface after partial disruption of the initial implantation site in the tubes. The pelvic cavity is the preferential site, but they have been reported from all over the peritoneal cavity. In the present case the pregnancy was situated on the surface of the right liver lobe. Abdominal pregnancies usually present with acute hemoperitoneum and the pre-operative diagnosis is extremely difficult. The possible role of IUDs as an etiological factor is briefly discussed.

PRIMARY HEPATIC PREGNANCY

A case of primary hepatic pregnancy presenting as a lithopedion in the right hypochondrium is presented. The lithopedion was removed and the patient recovered uneventfully. The diagnosis of primary hepatic pregnancy is briefly discussed.

Primary hepatic pregnancy.

<h3>Abstract</h3> Plant evolution has been a complex process involving hybridization and polyploidization making understanding the origin and evolution of a plant’s genome challenging even once a published genome is available. The oilseed crop, <i>Camelina sativa</i> (<i>Brassicaceae)</i>, has a fully sequenced allohexaploid genome with three unknown ancestors. To better understand which extant species best represent the ancestral genomes that contributed to <i>C. sativa</i>’s formation, we sequenced and assembled chromosome level draft genomes for four diploid members of <i>Camelina</i>: <i>C. neglecta C. hispida</i> var. <i>hispida</i>, <i>C. hispida</i> var. <i>grandiflora</i> and C. <i>laxa</i> using long and short read data scaffolded with proximity data. We then conducted phylogenetic analyses on regions of synteny and on genes described for <i>Arabidopsis thaliana,</i> from across each nuclear genome and the chloroplasts to examine evolutionary relationships within <i>Camelina</i> and <i>Camelineae</i>. We conclude that <i>C. neglecta</i> is closely related to <i>C. sativa</i>’s sub-genome 1 and that <i>C. hispida</i> var. <i>hispida</i> and <i>C. hispida</i> var. <i>grandiflora</i> are most closely related to <i>C. sativa</i>’s sub-genome 3. Further, the abundance and density of transposable elements, specifically <i>Helitrons</i>, suggest that the progenitor genome that contributed <i>C. sativa</i>’s sub-genome 3 maybe more similar to the genome of <i>C. hispida</i> var. <i>hispida</i> than that of <i>C. hispida</i> var. <i>grandiflora.</i> These diploid genomes show few structural differences when compared to <i>C. sativa</i>’s genome indicating little change to chromosome structure following allopolyploidization. This work also indicates that <i>C. neglecta</i> and <i>C. hispida</i> are important resources for understanding the genetics of <i>C. sativa</i> and potential resources for crop improvement.